Stages of Healing

Question 1

Electric stimulation, heat and cold therapy, mechanical energy, and light are all example of what kind of treatment category?

Answer 1

Electrophysical agents

Question 2

Are electrophysical agents primarily used as a primary treatment or a complementary treatment?

Answer 2

Complementary

Question 3

What is the difference between active and passive care?

Answer 3

Active = patient has to perform activity/exercise to achieve effect 
Passive = doctor applies intervention

Question 4

What are the 4 stages of healing (Belanger)?

Answer 4

1 hemostasis
2 inflammatory
3 proliferation
4 remodeling/maturation

Question 5

What is the duration for each stage of healing?

Answer 5

Hemostasis = seconds/minutes
Inflammatory = hours/days/weeks
Proliferation = weeks/months
Remodeling/maturation = months/year

Question 6

What are the 3 stages of healing (other model)?

Answer 6

1 inflammation
2 repair
3 remodeling

Question 7

What is another name for the inflammatory phase?

Answer 7

Acute phase

Question 8

What is the purpose of the inflammatory/acute phase?

Answer 8

1 defend against foreign intruders (infection)
2 remove damaged tissue and debris
3 immobilize area

Question 9

What types of tissue don’t heal well?

Answer 9

Avascular or poorly vascularized tissue

Question 10

What are the cardinal signs of inflammation derived from Celsus in A.D. 25?

Answer 10

Heat (calor)
Redness (rubor)
Swelling (tumor)
Pain (dolor)

Question 11

Which cardinal sign of inflammation was derived from Virchow in 1902?

Answer 11

Loss of function (functio laesa)

Question 12

What is the 6th sign of inflammation added by Belanger?

Answer 12

Muscle spasm

Question 13

What vascular changes are present in the inflammatory phase of healing?

Answer 13

1 vasodilation

2 increased capillary permeability

Question 14

What cells are responsible for the phagocytosis seen in the inflammation stage of healing?

Answer 14

Neutrophils and macrophages

Question 15

The inflammation stage of healing is controlled and initiated by approximately how many chemicals?

Answer 15

Over 180

Question 16

Bradykinin, prostaglandins, and serotonin are examples of chemicals that initiate what kind of sensation during the inflammatory phase of healing?

Answer 16

Nociception (pain)

Question 17

What type of injury can occur following too much inflammation during the healing process?

Answer 17

Secondary enzymatic injury or secondary hypoxic injury

Question 18

What occurs with secondary enzymatic injuries?

Answer 18

Lysosomal enzymes are released an attack healthy tissue

Question 19

What occurs with secondary hypoxic injuries?

Answer 19

Decreased O2 and nutrients leading to damage of surrounded uninjured tissue

Question 20

Hemorrhage, clotting, edema, spasm, and hematomas are all examples of what kind of injury following excessive inflammation?

Answer 20

Secondary hypoxic injury

Question 21

What are the ultimate goals of the inflammatory phase?

Answer 21

Limit extent of inflammation (only small amount needed)

Preserve range of motion (ROM)

Question 22

What is the acronym used for the inflammatory phase of healing?

Answer 22

PRICE:

Protect, rest, ice, compress, elevate

Question 23

What are the lengths of the acute phase of healing for ankle sprains for each grade type?

Answer 23

Grade 1 = 1-3 days
Grade 2 = 2-4 days
Grade 3 = 3-7 days

Question 24

What are the top areas of focus during the acute phase of an ankle sprain?

Answer 24

1 decrease swelling and pain
2 maintain motion and appropriate weight bearing
3 protect from re-injury

Question 25

What is another name for the proliferative phase?

Answer 25

Repair phase

Question 26

What is the term for the production of new capillaries during the proliferative phase of healing?

Answer 26

Angiogenesis

Question 27

What types of cells are primarily at work during the proliferative phase?

Answer 27

Fibroblasts, chondroblasts, osteoblasts

Question 28

What type of fibers and cells are found in the ECM during the proliferative phase?

Answer 28

Type III collagen & proteoglycans

Question 29

Why are Type III collagen fibers not ideal?

Answer 29

Weak, disorganized

Question 30

What term is the unconscious perception of movement and spatial orientation arising from stimuli within the body itself?

Answer 30

Proprioception

Question 31

How long does the proliferation phase last for each grade type of an ankle sprain?

Answer 31

Grade 1 = 2-4 days Grade 2 = 3-5 days Grade 3 = 4-8 days

Question 32

What are the goals of the proliferative phase of healing for an ankle sprain?

Answer 32

``` 1 decrease swelling and pain 2 increase pain ROM 3 begin non-weight bearing proprioceptive training 4 encourage and increase proliferation 5 provide protective support as needed ```

Question 33

What are examples of active care that can help in the proliferative stage of healing of an ankle sprain?

Answer 33

``` 1 proprioceptive training 2 range of motion 3 strengthening (carefully) ```

Question 34

What is another name for the remodeling phase?

Answer 34

Maturation phase

Question 35

What physiologic changes are seen during the remodeling phase?

Answer 35

1 scar contraction 2 decrease of blood vessels 3 type III collagen switching to type I

Question 36

What is the danger of scar contraction during the remodeling phase?

Answer 36

Can lead to joint adhesion and loss of motion

Question 37

What are the benefits on collagen of increasing tension on the connective tissue during the remodeling phase?

Answer 37

1 increased collagen fibril diameter 2 increased cross-linking 3 increased number of collagen fibrils 4 increased collagen fibril packing density 5 collagen is organized and aligned in parallel fashion 6 optimal strength

Question 38

How long is the remodeling phase of each grade type of an ankle sprain?

Answer 38

Grade 1 = one week Grade 2 = two weeks Grade 3 = three weeks

Question 39

What are the goals of the remodeling phase in reference to an ankle sprain?

Answer 39

``` 1 increase pain-free ROM 2 progress proprioceptive training 3 regain full strength 4 normal biomechanics 5 protect and strengthen any residual joint instability ```

Question 40

Which ligament is most commonly involved in an ankle sprain?

Answer 40

Anterior talofibular ligament (could also be posterior talofibular and calcaneofibular ligaments)

Question 41

Which muscles can be stretched following an ankle sprain to help with loss of dorsiflexion?

Answer 41

Gastrocnemius and soleus

Question 42

What are good exercises of active care for an individual with an ankle sprain to increase strength?

Answer 42

Heel/toe raises, stair steps, quarter squats, eccentric/concentric with cuff weights/theraband